Dr_Tej 🩺 MD

ENGINEERING MARVEL - HYDERABAD CHAPTER!! For a country where every third graduate is an Engineer, the beautiful, mind blowing structures we witness everyday is truly astounding. Here is a foot over bridge in Mehadipatnam, Hyderabad which was constructed recently! Citizens are now wondering if they should take up obstacle course training & practice commando crawls to literally make it from one end of the bridge to the other. Not one person involved in the entire decision process or those constructed ever walked on a FOB or may be even walked. They probably were just happy pocketing their share where definitely crores were spent! City: Hyderabad Government: Congress

Complements in disease: - Both C3/C4 - Lupus including lupus nephriits - C4 - cryoglobulinaemic vasculitis - C3 - membranoproliferative GN, post-streptococcal Recurrent low C4 - consider hereditary angioedema

🧠 Ammonia in liver failure is not just a lab value. It’s a brain toxin. And in the ICU… it can kill. 🔬 Key concept: 👉 Hyperammonemia = central driver of neurological deterioration Not just a marker, a mechanism ⚠️ What ammonia really does: • Crosses the blood-brain barrier • Accumulates in astrocytes • 👉 Causes cerebral edema + intracranial hypertension • 👉 Can progress to brain herniation 📊 Clinical impact: • Ammonia >150 µmol/L 👉 ↑ risk of: • Hepatic encephalopathy • Cerebral edema • Mortality 🧬 But it doesn’t stop at the brain: 👉 Hyperammonemia also causes: • Immune dysfunction • Increased infection risk • Multi-organ failure trigger 🧠 ALF vs ACLF — not the same disease 🔴 Acute Liver Failure (ALF) • Rapid hepatocyte loss • 👉 Higher ammonia peaks • 👉 Higher risk of brain edema 🟠 ACLF • Chronic adaptation • 👉 Less cerebral edema • 👉 More systemic organ failure 📉 Important ICU insight: 👉 Normal ammonia ≠ exclude encephalopathy 👉 But high ammonia = strong prognostic signal 🧪 Measurement pearls: • Arterial > venous • Serial values > single measurement • Affected by: - Infection - GI bleeding - Sarcopenia - Renal failure 💊 Treatment is multi-targeted: 🟢 Gut reduction • Lactulose • Rifaximin 🟡 Metabolic pathways • L-ornithine-L-aspartate 🔴 Clearance • CRRT → most effective sustained removal • IHD →more clearance but worst survival! 🚨 Key ICU takeaway: 👉 In liver failure, ammonia is: • A neurotoxin • A prognostic marker • A therapeutic target 🎯 Clinical mindset shift: Don’t just ask: 👉 “What is the ammonia level?” Ask: 👉 “What is the brain risk right now?” 📖 Reference: Duarte T et al. (2024). Journal of Critical Care. doi.org/10.1016/j.jcrc…

For 4 years, Nida Khan has been helping Asif Ansari, Tausif Attar, Shafi Sheikh, Raza Memon, Danish Sheikh, and Shah Rukh Quresh trap Hindu females at TCS Nashik These secular Hindu females must have trusted and wished Iftar, Ramzan, and Eid to Nida Khan and her friends In the end, what they got was forced religious conversion, their faith being mocked, being forced to eat beef, and whatnot

@Glorious_breeze @ReddyMoksh Cry clown🤣🤣 flop remakes

@ReddyMoksh Telugu clown fans crying over Thalapathy never stop! Cry louder boys !

Never thought Ravipudi direction would be better than the guy's who made Theeran.

Three individuals arrived armed with a sword, allegedly to attack someone. Thankfully, a brave neighbour recorded the incident and warned them, possibly preventing serious harm. This is a serious threat to public safety. I request the authorities to act immediately, identify the accused and take strict action before things escalate further. The person who recorded this video may also be at risk and needs protection. Vehicle number (as seen in the video): KA05 QM 5962 Kindly treat this with urgency and ensure the safety of citizens. A Big salute 🫡 to Video recorded person 🙏🏻🙏🏻💪🏻💪🏻 @blrcitytraffic @CPBlr @DrParameshwara

After TCS Now Tech Mahindra @tech_mahindra Love j!had cases under light Whats happening @PiyushGoyal @HMOIndia @AmitShah It's all looks planned @anandmahindra was Yasin Malik supporter too Is he involved?? Big scrutiny due!! Cc @narendramodi VishwaGuru ji Ghar samhalna hai pehele!!

Received Instagram DM of girl employee: At Tech Mahindra office, pantry declared “Footwear-Free Zone” till Ramzan for prayers & iftar. Colleagues asked to follow it in the name of “unity”. Question is simple: Is workplace policy now religion-based, or should it remain neutral for all?

🚨 HISTORIC RESULT FT. AYUSH SHETTY First Indian Men's Singles player to reach the Badminton Asian Championship after 61 Years! 💥 WELL DONE CHAMP! 🇮🇳❤️

Major shifts in stroke management 2026

🧠 Clinical Approach to Headaches Headaches are one of the most common complaints in clinical practice. The challenge lies in distinguishing between benign primary patterns and life-threatening secondary emergencies. Here is your step-by-step organized guide. 📚 Our Neurology Book provides high-yield, visual summaries designed to help you ace your exams and clinical rotations! 🔗 Get the Neurology Book here: mediconotes.com

Received a concerning message from an employee at a Tech Mahindra BPO in Goregaon, alleging biased hiring practices, unequal workplace policies, and religious favoritism during festivals. If true, this raises serious questions about corporate neutrality and fair work culture. Authorities & company leadership must look into this urgently. ⚠️ @anandmahindra @tech_mahindra

Case by Dr Rajesh Chandra Mishra: A 70-year-old male, a known case of Hypertension, presented with an acute Myocardial Infarction. Coronary angiography revealed severe triple vessel coronary artery disease, and echocardiography showed markedly reduced left ventricular systolic function with an ejection fraction of approximately 10%. Notably, despite the severe systolic dysfunction, the left ventricular geometry was preserved, suggesting maintained structural integrity (“LV skeleton maintained”) without significant adverse remodelling. During the index admission, the patient developed cardiogenic shock requiring high-dose inotropic and vasopressor support. He was managed with insertion of an Intra-aortic Balloon Pump and invasive mechanical ventilation. With careful hemodynamic monitoring and tailored fluid management, the patient showed gradual clinical improvement. The IABP was successfully removed on day 4, and he was weaned off mechanical ventilation by day 7. By day 10, he was stable enough to be shifted to High-Flow Nasal Cannula, and subsequently discharged in a hemodynamically stable condition. At discharge, he was prescribed dual antiplatelet therapy along with a direct oral anticoagulant. However, guideline-directed medical therapy for heart failure could not be initiated due to persistent hypotension, with mean arterial pressures in the range of 55–60 mmHg. As a supportive measure to optimise cardiac function, he was advised nocturnal Continuous Positive Airway Pressure. Approximately 10 days after discharge, the patient developed sudden onset right-sided hemiparesis and was brought to the emergency department within 30 minutes of symptom onset. An urgent CT scan of the brain showed no evidence of intracranial hemorrhage. Given the early presentation within the therapeutic window, intravenous Tenecteplase (12 mg) was administered in the emergency room. A subsequent CT angiogram did not reveal any large vessel occlusion. Following thrombolysis, the patient demonstrated early neurological improvement, with return of limited speech and partial motor recovery in the right upper and lower limbs. Over the next 48 hours, he showed near-complete recovery of right-sided motor function, with only mild residual speech impairment. His clinical condition remained stable, and he was discharged again on day 5. This case highlights that patients with severe left ventricular dysfunction remain at high risk of cardioembolic events despite being on dual antiplatelet therapy and anticoagulation. The preserved LV geometry in this patient suggested potential for myocardial recovery, yet the profound systolic dysfunction created a low-flow, prothrombotic state predisposing to early stroke. Importantly, the case underscores that timely thrombolysis should be strongly considered in such patients if they present within the window period and neuroimaging excludes hemorrhage, as significant neurological recovery is achievable even in high-risk cardiac patients. — Dr. Rajesh Chandra Mishra Past President ISCCM | Past Chancellor ICCM.Past India Representative to ESICM | Past General Secretary ISCCM

In Jubilee Hills, a drunk driver driving a BMW was caught using a high-tech system to swap number plates and dodge traffic fines, Traffic cops left stunned as the accused tried to fool them with remote operated Chinese flip number plates. Case registered. #Hyderabad

Circulation

studying microbiology and ofc actinomyces israelii is an opportunistic invasive bacterium…subtle as a brick

Her name is Rohini Sindhuri. She is a 2009 batch IAS officer posted in Karnataka. In 2018, she was the District Collector of Hassan. She discovered illegal sand mining happening every night from the rivers in her district. She stopped it. Local politicians were furious. They went to the Chief Minister. Within days, she was transferred out of Hassan. She fought it in the Karnataka High Court. The court ruled her transfer was illegal and ordered the government to reinstate her. The government reinstated her. Then transferred her again. She went back to court. She kept going back to court every single time the system tried to silence her. Between 2018 and 2023, she was transferred seven times. Each transfer came within weeks of her exposing something. She never stopped working. She never stopped filing cases. She never stopped showing up. India has a system where honesty is punished with transfers. Rohini Sindhuri refused to accept that as her final answer. She is still in service today. Follow for real stories about people who refused to quit.

Specific Tests 🔹 Tuberculosis (TB) – Mantoux Test 🔹 HIV/AIDS – ELISA Test 🔹 Malaria – Rapid Diagnostic Test 🔹 Typhoid – Widal Test 🔹 Diabetes – HbA1c Test 🔹 Heart Attack – ECG, Echocardiography 🔹 Alzheimer’s Disease – Cognitive Tests 🔹 Breast Cancer – Mammography 🔹 Cervical Cancer – HPV Test 🔹 Lung Cancer – Biopsy 🔹 Chronic Kidney Disease – eGFR Test 🔹 Urinary Tract Infection (UTI) – Urine Culture 🔹 Jaundice – Bilirubin Test 🔹 Hepatitis B – HBsAg Test 🔹 Dengue – NS1 Antigen Test 🔹 Syphilis – VDRL Test 🔹 Anemia – Complete Blood Count (CBC) 🔹 Prostate Cancer – PSA Test 🔹 Pneumonia – Chest X-ray

Ayush Shetty bro...🔥🔥🔥 That should be declared illegal 🤯